A patient with patience... or trying.

I asked the OB to screen me early for gestational diabetes. My numbers confirmed my gestational diabetic status.

I met with the Endocrinologist, a.k.a. Insulin doctor. I had a list of questions, the information from the registered dietician and the blood results from my tests. I started in with my questions….

When and where do I get a glucose monitor? – He gave me one, and a prescription for more testing strips.
I took Metformin for PCOS 1500 mg/day. Can I take it instead of shots? – No, pill cross the placenta, injections don’t.
Will I have a nurse manager that I check in with periodically? - No, I go directly to him every two weeks.
I don’t know my last Hemoglobin a1c test. When will I have one drawn? Friday morning, along with a bunch of other baseline things he wants on record.
I don’t have a refill for my thyroid medicine after this 30 day period, can you do that? Yes – he’d call it in with the other prescriptions.
Do I need Ketone strips? Yes, 3-times a day. He wrote a prescription and had it faxed in. I didn’t have high Blood Pressure or swelling with Jacob, but I’m starting some mild swelling with this one, is that ok? Yes, swelling is very normal.

He concluded very quickly that I had my act together. I stated the obvious, “I’m a very active patient and involved in what’s going on”. He said “That’s good…”, but I wonder how many doctors really mean that.

He confirmed that I have all the makings of a gestational diabetic. He’s more cautious with insulin than I would like. Before taking that leap and prescribing injections, he wants to see my blood work and a week of blood sugar readings. I will take my blood sugars six times a day for the next week and meet with him again. Based on my blood sugar log, he will then start me on the long lasting – slow release – insulin (NpH). I’ll take the NpH for two weeks and continue keeping a log of my blood sugars six times a day.

If at that time he feels I need to go to the fast acting – meal response – insulin, I’ll start small amounts before each meal and probably move the NpH to the night function.

The treatment plan when I was pregnant with Jacob was the fast acting - meal response – insulin each meal and then NpH overnight. I suppose I will have wait three weeks to get to the same result that the other doctors jumped right into.

Then he started in with my instructions. He made me write it all down on the piece of paper I brought in with his questions. If I could make a list for him, he was surely going to have me leave with a list from him.

He’d like to see my blood sugars in the ranges below:

Fasting 65-95
Before meal 90-105
1 hour after meal 140 maximum
2 hours after meal 120 maximum

Something he’s having me do that I did before, but not with the frequency. He is having me test for Ketones 2-3 times a day. What is a ketone you may ask? If you don’t have blood sugar available to feed the baby, your body will call upon fat reserves to make food. A by-product of that process is Ketones being produced. Ketones are not good for the baby. He doesn’t want me to skip blood sugar, but rather balance enough to feed the baby, without sugars too high.

If I have trace or a positive 1 ketone, I need to add 1 diabetic exchange for carbohydrates.
If I have a moderate level of ketones, I need to add 2 diabetic exchanges for carbohydrates.
If I have a large level of ketones, I need to add 3 diabetic exchanges for carbohydrates and call the office.

With all this in mind…I showed the doctor my meal plan as laid out by the registered dietician. The numbers are the servings of that food group recommended at that meal.

Breakfast 3 starch 1 meat 1 fat
Snack 1 fruit 1 milk
Lunch 2 starch 1 fruit 2 vegetable 3 meat 2 fat
Snack 1 starch 1 milk
Dinner 2 starch 1 milk 2 vegetable 3 meat 1 fat
Snack 1 starch 1 fruit 1 milk

I didn’t eat that much at breakfast. I had a piece of banana bread with a little butter. I came close to the recommendation. My fasting this morning was 120 and I had a 1 hour after the meal reading of 194. I suppose I can give him these numbers tomorrow when I go to the lab. Maybe he can start the insulin a little earlier.

Patience….